M. Cesarik et al.: Roman Military Medicine, Coll.Coll. Antropol. Antropol. 40 40 (2016) (2016) 3: 3: ???–??? ???–??? Original scientifi c paper

RRomanoman MilitaryMilitary MMedicineedicine aandnd CCroatianroatian AArchaeologicalrchaeological PPerspectiveserspectives

MMarijanarijan CesarikCesarik1, NNikolaikola CCesarikesarik2, DDarkoarko DDuplanuplančić3, DDavidavid ŠŠtrmeljtrmelj4

1 Požega County General Hospital, Department of Neurology, Požega, . 2 University of , Department of Archaeology, Zadar, Croatia. 3 University of Split, University Hospital Centre Split, Split, Croatia 4 Vjekoslava Maštrovića 19, 23000 Zadar, Croatia

AABSTRACTB S T R A C T

This article offers a general examination of the sources responsible for understanding Roman military medicine, start- ing with literal and epigraphical sources all the way to archaeological remains consisting of hospitals, the infrastructure of military garrisons and small medical tools. Given that not one of the literary sources does not directly mention the medical personnel within the various military units, epigraphical discoveries widely represent the main source of our knowledge on the subject. On the other hand, the archaeological exploration of military garrisons offers proof of the medical care of Roman soldiers. If at fi rst it appears that Roman military medicine is perfectly obvious and clear, actu- ally this is not the case as many questions remain to be answered and debated. In all this, Croatia has its own archaeo- logical perspective, where notably, one site stands out, which could hold a key role according to the layout of buildings within the garrison including its hospital.

Key words: Roman Military Medicine, epigraphy, archaeology, Roman military camps, Burnum

IIntroductionntroduction

The Roman army of the Principate was certainly one sources on the matter, but also to show what the main of the most effi cient and most organized armies of all time. evidence and problems are regarding reconstructing the Military organisation and hierarchy, defi ned pattern of organisation of Roman military service and present Croa- military advancement, but also the art of warfare itself tian archaeological perspectives in contributing and an- were perhaps Rome’s greatest achievement and legacy. It swering the question. was the pillar on which all other civilizational acquisitions stood – from art and urbanization to economy and com- SSecondaryecondary SourcesSources merce. A clearly defi ned hierarchical system, logistical backup Many authors have written on the subject of Roman and the art of discipline were the main conditions for the military medicine, but the work of Roy Davies is still the 1–4 success of Roman army, but one thing that certainly de- most fundamental one . He processed the literary sourc- veloped its effi ciency was the organisation of military es and epigraphical evidence, as well as the archaeological medical service. remains, and not much has changed since he wrote his articles. Patricia Baker has handled the matter from a Although there is a lot of evidence, which proves that strict archaeological view5, and recently Lawrence J. Roman military units had different varieties of medical Bliquez has published a monograph on Greek and Roman services inside their forts and fortresses, none of the sour- medical tools6. The last, thoroughly interesting paper on ces speak of it directly, so many claims about Roman the matter has come from the pen of Duncan Campbell7. military medicine are still the questions of debate. Con- There are also some works that tried to re-open some of sequently, it would be helpful to present the primary the questions, but they will be presented below.

Received for publication August 19, 2016

1 M. Cesarik et al.: Roman Military Medicine, Coll. Antropol. 40 (2016) 3: ???–???

LLiteraryiterary SourcesSources tamination of water and the fouls the smell itself, as the drinking water is tainted and the air infected. The only There are not many literary sources that address Ro- way to prevent this is frequent changes of encampment.« man military medicine, and as we said before, none of As can be seen, Vegetius does not tell anything about them is strictly devoted to it. The work of Vegetius is cer- the organization of the physicians in the Roman army, but tainly the most important one (and is certainly the most is simply saying what an army should or should not to do detailed one), but with the main problem being that ‘was in certain situations. But still, his words show that health neither a historian nor a soldier: his work is a compilation was of great importance to the army’s effi ciency and that carelessly constructed from material of all ages, a conge- the health of soldiers was the duty of their offi cers and 8 ries of inconsistencies’ . It is not clear when actually Veg- commanders. Although he emphasized that regular exer- etius wrote his work, but it was certainly written at the cise is more benefi cial to health than any kind of medicine end of the fourth and the beginning of the fi fth century (i.e. that the best way to treat the illness is not to get it at AD. Since he wrote in the period when the Roman state all), Vegetius’ passage is important because it proves that had lost its infl uence and strength, and when the military physicians had a certain role in the organisation of the glory of Rome had vanished long ago, it is not surprising Roman army. that Vegetius often criticised the army of his age calling There is another reference on military medicine by upon the days of glory. The most important passage of Vegetius, where he mentions that the prefect of the camp Vegetius on the matter of military medicine is in the third is in charge of the medical organisation of the legion (Veg- book of his De re militari where he writes on the means of etius, On military matters, 2.10): preserving the health of soldiers (Vegetius, On military matters, 3.2): »He was responsible for the sick soldiers and the medi- ci by whom they were looked after, and also the expenses »Now, I shall discuss a matter which must be given the involved.« utmost care: the means whereby the health of the army The rest of the sources about military medics are very may be preserved, namely by situation, water-supply, sea- poor. For instance, Galen – one of the most famous physi- son, medicine, and exercise. As far as situation is con- cians in antiquity – criticises the army doctors during the cerned, do not keep the troops in an unhealthy region in Marcomannic wars of Marcus Aurelius, for not using the the vicinity of marshes that bring diseases, on arid plains bodies of death barbarians in their own improvement of or hills lacking trees to provide shade, or in summer out knowledge (Galen, On the composition of medicine, of doors without tents. Do not let them contract ailments 13.604.). According to the Historia Augusta, the emperor through the heat of the sun and the fatigue of the journey Aurelian declared that the soldiers should get medical as a result of setting out too late, but rather in time of care without charge (Historia Augusta, Life of Deifi ed excessive heat they should start the journey before day- Aurelian, 7.8.): break, and thus reach their destination in good time. In the depths of winter do not let them march through snows »Let one yield obedience to another as a soldier and no and frosts by night, nor suffer from lack of fi rewood or one as a slave, let them be attended by the physicians inadequate supplies of clothing. A soldier who is compelled without charge, let them give no fees to soothsayers, let to freeze, is not suited for campaign or health. Do not allow them conduct themselves in their lodgings with propriety, the army to use water that is unwholesome or marshy, as and let anyone who begins a brawl be thrashed.« drinking bad water, just like poison, causes illnesses for There is also the statement of Modestinus (preserved the men. It is the constant duty of senior offi cers, com- in Justinian’s Digest) that the military doctors were ex- manding offi cers, and generals to seek diligently that sick empt from taxation because their profession served the soldiers should be brought back to health by suitable food state (Digest of Roman law, 4.6.33.2). Justinian’s Codex and cured by the skills of the doctors. Men who are hard preserved an edict of Emperor Antoninus Pius in which it pressed by the exigencies of war and illness, are badly off. is stated that the legionary physician was exempt from But experts in military matters have been of the opinion civic duties while he served the state, and that he would that as far as the health of the troops is concerned, daily enjoy his profession’s privileges on his return to civilian exercises with arms is of greater benefi t than doctors. Ac- life (Codex Iustinianus, 10.53.1). cordingly, they wished the infantry to be exercised under »If, as you allege you are serving as the physician of cover without interruption from rain or snow and on other the Second Legion, you cannot be compelled to perform days in the open. Similarly, they ordered the cavalry to civil services as long as you are absent on business for the exercise rider and horse continually in the plains and also State. After your connection with the army has ceased, on broken ground and diffi cult terrain pitted with gullies; however, and you have returned, you will be entitled to their aim was so that nothing could happen in the exi- exemption, if you are included in the number of those phy- gency of battle that was unknown to them. From this, one sicians to whom this privilege has been granted.« may learn how much more assiduously an army must be The only other ancient source referring to military doc- always trained in the art of weapons, as practice in hard tors is Paternus’ statement preserved in Justinian’s Digest work can bring health in the camp and victory in battle. where it is said that the military medici belonged to a If a large number of troops remain for some considerable group of immunes, which means that during the service, amount of time in summer or autumn in the same place, they were freed (i.e. immune) from physical labor (Digest this can cause very unwholesome diseases from the con- of Roman law, 50.6.7).

2 M. Cesarik et al.: Roman Military Medicine, Coll. Antropol. 40 (2016) 3: ???–???

Although all of these written sources are scarce at best, authors thought that the medicus ordinarius was a mili- they are still very useful because they confi rm that the tary doctor with the rank of a centurion, but the title doctors were involved in the military organisation and should probably be linked with the rank of miles medicus. that they had a certain status and position in the overall Consequently, it seems that the phrase medicus ordina- military hierarchy. However, the literary sources cannot rius comes from the fact that the physician emerged from answer other interesting and numerous questions; for ex- the ranks of the army (in ordine militat) as opposed to a ample those concerning the overall organisation of the doctor who joined the army from civilian life on a short medical corps. In order to answer these and similar ques- term contract. Thus it seems that they were professional tion we need to examine the epigraphic evidence. soldiers attached to units until the end of the prescribed conditions of service. Therefore, epigraphy provides a number of additional EEpigraphicpigraphic SourcesSources facts on medical functions in the Roman military units, Generally speaking, epigraphy is the single most im- and proves that the Romans had quite impressive and portant source for the study of Roman military hierarchy, superbly organised medical care for their soldiers. But career advancement and positioning of military units9. So neither literary nor epigraphic sources can tell us about far, several hundred thousand inscriptions have been re- the health conditions of individual Roman soldiers. The corded in the entire Roman world, and they greatly com- only way one could answer those questions is to conduct a plement (and often correct) literary sources. The inscrip- systematic archaeological excavations. tions are mostly published in large epigraphic corpora, such as Corpus Inscriptionum Latinarum (CIL), Inscrip- AArchaeologicalrchaeological SSourcesources tiones Latinae Selectae (ILS), or journals such as L’Année épigraphique (AE), and the vast majority of them are in- In terms of military medicine, archaeological remains cluded in the Epigraphik-Datenbank Clauss / Slaby can be broadly divided into two main groups. First, of (EDCS). Concerning Roman military medicine, the epi- course, are the remains of architecture – not only the re- graphic monuments bring to light not only the knowledge mains of military hospitals (fi gure 1), but all architec- about various medical positions in the army, but also the tural infrastructure that had some kind of infl uence on fact that the medical staff was detached to almost all types human health, such as water supplies, sewerage systems of military units. In addition to the main striking force of etc10. Others are small archaeological fi nds, such as med- the Roman empire – the legion – medical staff was in- ical tools that are found in large numbers within the cluded among the auxiliary units (cohortes and alae), military camps11, which again prove the high level of med- within the units garrisoned in the city of Rome (cohortes ical care within the Roman army. Through their examina- preatoriae, cohortes urbanae, cohortes vigilum, equites tion, scholars can do comparisons with, for example, surgi- singulares Augusti), but also within the navy (classis cal tools of our time, but also observe what skills the Ravennas, classis Misenensis) and irregulars (numeri). ancient physicians possessed. But there is one problem in From the epigraphic monuments we can observe that all of this – the fact that the material remains of Roman the doctors in the army were not only general practitioners valetudinaria and of medical tools have often been in the (medici), but there was also a whole range of specialists cause-effect relationship. The military camps had really (medicus chirurgus – surgeon; medicus ocularius – ocu- complex architecture and internal distribution of rooms, list) and additional staff personnel (e.g. capsarii – dress- with a wide range of different buildings, such as the com- ers, librarii – secretaries, marsi – experts for antidotes, mander’s household, barracks, stables, baths, granaries, seplasiarii – pharmacists specialised in ointments). reservoirs, sanctuaries and so on12. In the early years of Although, according to the Vegetius, the prefect of the camp was in charge for the medical organisation of the legion, the entire medical staff was led by medicus, while the hospital was run by optio valetudinarium, whose func- tion was more administrative, and it seems that he was not obliged to have any medical training. Although Pater- nus states that the medici and optiones valetudinarii be- longed to a group of soldiers liberated from physical work, it is more likely that they were principales, or in today’s terms non-commissioned offi cers who received double pay. In the navy physician had the title medicus duplicarius, which means that he was on double pay. There are also several functions, or better to say titles, for which a satisfactory explanation has never been dis- played, not only due to lack of literary and epigraphic sources, but also because of the etymology of certain words in those titles. It is still not clear what is hiding behind the terms medicus clinicus and medicus ordinarius. Some Fig. 1. Valetudinarium at Novae (photo Ž. Miletić)

3 M. Cesarik et al.: Roman Military Medicine, Coll. Antropol. 40 (2016) 3: ???–??? archaeological excavations (more than 100 years ago), the On the other hand, military encampments in structure where large quantities of medical tools were have been the subject of archaeological excavations (with found was characterised as veletudinarium, which led to large interruptions) for more than a century. The two a general acceptance in all the works that followed after. main military centres in Dalmatia were the legionary for- Even if in the buildings that should represent valetudina- tresses Tilurium and Burnum, and both camps are the rium no medical tools were found during the excavations, subject of systematic archaeological excavations started that building would be characterized as a hospital, be- in late 1990s and early 2000s20–21. Besides them, in the cause of the position and/or layout of the structure (the hinterland of the province, a small number of auxiliary hospital is in general, the building with an internal court- camps have been spotted, but only those located in pres- yard which is surrounded by various rooms) was analogue ent-day Bosnia and Herzegovina were the subject of ar- to fi t as valetudinaria from earlier investigated encamp- chaeological excavations23–25. ments. However, with all due respect, of all the military camps Because of that, Patricia Baker questioned whether in the province of Dalmatia – and in Croatia in general Roman valetudinaria were fact or just a fi ction, and in – the legionary fortress of Burnum has the greatest per- purely archaeological terms, she concluded that according spective to become an archaeological site of national and to analogies with earlier research – and according to the world importance. In the fi rst place because of its location, fi ndings of medical tools – the character of valetudinarium but also because of the fact that it is a so-called ‘dead site’, cannot be determined without doubt13. Sometimes medical meaning the location where there are no later building tools were found in great numbers in other structures, phases, which of course provides extremely good condi- which we know had different purposes, and buildings that tions for free research maneuvers (fi g. 2). Also, the fact have been determined as valetudinarium subsequently that Burnum is located within the National Park, is turned out to have had a completely different function. Yet what gives the site the qualities to become a usable ar- Ernst Künzl tried to refute the theory of P. Baker, by pub- chaeological dig, i.e. the potential can meet both scientifi c lishing an altar dedicated to Aesculapius and Hygiea and economic goals. found inside the structure, which has long been desig- nated as valetudinarium within the legionary camp Novae on the lower Danube 14. However, criticism of P. Baker, though perhaps inac- curate, is very important for anyone involved with this issue. In other words, one should never follow someone else’s opinion and conclusions without constant reviewing and proofi ng. A question of the organisation of the Roman military medicine is by no means a closed chapter, and will certainly open up new questions and reach new con- clusions with new evidence. All in all, Croatia has its ar- chaeological perspectives on the subject, and there is one important archaeological site that in terms of spatial or- ganisation of military camps (valetudinarium including) could have a key role.

CCroatianroatian PPerspectiveserspectives Fig. 2. The legionary fortress of Burnum (courtesy of Archeological Collection Burnum) The territory of present-day Croatia was divided main- ly between two provinces: Pannonia and Dalmatia (ear- lier province of Illyricum),15–16 while the region of Istria Regarding the topic of Roman military medicine, Bur- belonged to one of the eleven regions of Italy (Regio X num has already spawned some interesting information, Venetia et Histria). The Roman army was present in Pan- such as the funerary stele of Satrius Rufus showing the nonia as well as in Dalmatia, but the archaeological re- box with medical tools (fi g. 3)26–27. This is a unique case, search was – in general – more focused on the Dalmatian because the text on the monument states that Rufus was part. During the last years of the Republic and in the an ordinary soldier of legion XI Claudia Pia Fidelis (miles early years of the Principate, one of the main military legionis XI Claudiae Piae Fidelis; AE 1903, 376), but the strongholds in Pannonia was Siscia17. But although in the displayed medical tools show that the deceased obviously vicinity of present-day Sisak extremely large amount of had medical training, and that he was connected within Roman military equipment have been found18, up to this the medical staff of legion XI. His case can be linked with day, the exact position of the military camp has not been the title of miles medicus that occur in inscriptions, and it precisely determined. In the most easternmost parts of seems that the title was used to separate those doctors Croatia, on the western banks of the Danube, several aux- who emerged from the ranks of the army, from those who iliary camps were perceived, but neither of them has un- joined the army as civilians. In any case, Rufus was prob- dergone systematic archaeological excavations19. ably not a real physician, but perhaps only a medical tech-

4 M. Cesarik et al.: Roman Military Medicine, Coll. Antropol. 40 (2016) 3: ???–???

Fig. 5. Medical tools from Burnum (courtesy of Archeological Collection Burnum)

Fig. 3. Stele of Satrius Rufus But what stands out, and why Burnum can greatly (after N. Cambi; cited in the references) contribute to our knowledge about the organisation of medical care within the Roman military encampments, is the fact that there is a completely unexplored valetudina- nician or medical orderly. Unlike Satrius Rufus, on one rium (fi g. 6). In addition, the fact that Burnum became a monument from Burnum a real medicus legionis is re- legionary fortress at the end of Augustus’ and the begin- 28 corded , whose name was probably Varius Aristo (fi g. 4). ning of Tiberius’ reign, and that as such it served approx- During the systematic archaeological excavations of Bur- imately to the beginning of Hadrian’s rule, provides ex- num, a large quantity of medical tools was found (fi g. 5), ceptional opportunities for understanding the layouts of which are yet to be processed and published. military fortresses during the 1st century AD. Therefore, the site has a worldwide importance, since many of so far investigated camps in the Roman world were used for many centuries, so many alterations annulled earlier ones, and often they are located in the hearts of today’s European capitals such as Vienna (Vindobona), Budapest (Aquincum) or Belgrade (Singidunum).

Fig. 4. Ideal reconstruction of funerary stele of Varius Aristo, Fig. 6. Proposed location of valetudinarium at Burnum medicus of legio XI (drawing by V. Medić) (courtesy of Archeological Collection Burnum)

5 M. Cesarik et al.: Roman Military Medicine, Coll. Antropol. 40 (2016) 3: ???–???

CConclusiononclusion teers and visitors, which means that Burnum could be- come a sustainable project which can create surpluses, If until now questions exist whether the Roman mili- and not just the cost. tary valetudinaria are fi ction or fact, we are sure that a detailed and systematic archaeological research of the le- gionary camp in Burnum would certainly sort out (or ex- AAcknowledgementscknowledgements pand) our current views and knowledge on the subject. From this approach, the benefi t could not have only ar- We would like to express our gratitude to Professor chaeological signifi cance, but also the part of the public Željko Miletić, who kindly provided us with photos and which focuses on the general history of medicine. In addi- information about the archaeological excavations at Bur- tion, the site also has exceptional economic perspective, num. because its location can attract a large number of volun-

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M. Cesarik

Požega County General Hospital, Department of Neurology, Osječka 107, 34000 Požega, Croatia e-mail: [email protected]

RRIMSKAIMSKA VVOJNAOJNA MMEDICINAEDICINA I HRVATSKEHRVATSKE AARHEOLOŠKERHEOLOŠKE PPERSPEKTIVEERSPEKTIVE

SSAŽETAKA Ž E T A K

Članak donosi opći pregled izvora za poznavanje rimske vojne medicine, počevši od literarnih i epigrafskih izvora pa sve do arheoloških ostataka poput bolnica unutar vojnih logora i sitnih medicinskih alata. Budući da niti jedan od liter- arnih izvora ne govori direktno o ustroju medicinskog osoblja unutar vojnih jedinica, epigrafski nalazi u mnogočemu predstavljaju glavni izvor po tom pitanju. S druge strane arheološka istraživanja vojnih logora pružaju dokaze o samoj medicinskoj skrbi rimskih vojnika. Iako se naočigled čini da je po pitanju rimske vojne medicine sve čisto i jasno, to ipak nije tako, te su mnoga pitanja o toj temi i dalje predmet debata. U svemu tomu i Hrvatska ima svoje arheološke perspe- ktive, a posebno se ističe jedan lokalitet koji bi po pitanju rasporeda prostorija unutar vojnih logora, pa tako i vojnih bolnica, mogao imati i ključnu ulogu.

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